Medicare-Medicaid Plan (MMP) Quality Withhold Methodology & Technical Notes

MMPs participating in the capitated model will have a portion of their rates withheld; payment of these withheld amounts is subject to performance consistent with established quality requirements. The quality withhold analysis results for each demonstration will be posted to the state-specific pages as they become available.

More information on the Quality Withhold (QW) methodology and benchmarks is available below:

• Capitated Financial Alignment Demonstration Year 1 QW Methodology & CMS Core Technical Notes (06/06/2014) (PDF)
• Capitated Financial Alignment Demonstration Years 2 - 12 QW Methodology & CMS Core Technical Notes (10/19/2023) (PDF)

Additionally, information about the QW adjustment for extreme and uncontrollable circumstances (such as major natural disasters) and QW impacts due to the Coronavirus Disease 2019 (COVID-19) public health emergency (PHE) can be found in the memoranda below:

• Quality Withhold Adjustment for Extreme and Uncontrollable Circumstances (04/01/2019) (PDF)
• Quality Withhold Impacts due to the COVID-19 Public Health Emergency (07/29/2020) (PDF)
• CY 2021 Quality Withhold Analysis Update Memorandum (11/17/2021) (PDF)

California

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for California (PDF)
• Capitated Financial Alignment Demonstration Years 2-8 QW Methodology for California (PDF)

Illinois

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for Illinois (PDF)
• Capitated Financial Alignment Demonstration Years 2-11 QW Methodology for Illinois (PDF)

Massachusetts

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for Massachusetts (PDF)
• Capitated Financial Alignment Demonstration Years 2-12 QW Methodology for Massachusetts (PDF)

Michigan

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for Michigan (PDF)
• Capitated Financial Alignment Demonstration Years 2-10 QW Methodology for Michigan (11/05/2024) (PDF)

New York - Fully Integrated Duals Advantage (FIDA)

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for New York - FIDA (PDF)
• Capitated Financial Alignment Demonstration Years 2-5 QW Methodology for New York - FIDA (PDF)

New York - FIDA Intellectual and Development Disabilities (FIDA-IDD)

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for New York - FIDA-IDD (PDF)
• Capitated Financial Alignment Demonstration Years 2-9 QW Methodology for New York - FIDA-IDD (PDF)

Ohio

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for Ohio (PDF)
• Capitated Financial Alignment Demonstration Years 2-11 QW Methodology for Ohio (PDF)

Rhode Island

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for Rhode Island (PDF)
• Capitated Financial Alignment Demonstration Years 2-9 QW Methodology for Rhode Island (PDF)

South Carolina

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for South Carolina (PDF)
• Capitated Financial Alignment Demonstration Years 2-10 QW Methodology for South Carolina (PDF)

Texas

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for Texas (PDF)
• Capitated Financial Alignment Demonstration Years 2-10 QW Methodology for Texas (PDF)

Virginia

(demonstration ended 12/31/2017)

• Capitated Financial Alignment Demonstration Year 1 QW Methodology for Virginia (PDF)
• Capitated Financial Alignment Demonstration Years 2 & 3 QW Methodology for Virginia (PDF)

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